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Module 6: Repro/Endocrine > Pathology: Female Genital System > Flashcards

Pathology: Female Genital System Flashcards

1
Q

What type of cellular layer is on the vulva?

A

Sqamous epithelium

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2
Q

What is a bartholin cyst?

A

Cystic dilation of Bartholin gland (which secretes mucous-like fluid which lubricates the vulva/vagina)

  • Arises due to inflammation and obstruction of gland; usually occurs in women of reproductive age; often related to infection and STI’s
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3
Q

What is the clinical presentation of a Bartholin cyst?

A

Unilateral, painful cystic lesion

  • Lower vestibule adjacent to vaginal canal
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4
Q

What is a Condyloma?

A

Warty neoplasm of squamous epithelium (of the vulva); often large

  • Most commonly due to HPV types 6 or 11
  • Characterized by koilocytic change
  • Rarely progresses to carcinoma
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5
Q

What defines High Risk or Low Risk HPV infections?

A

Based on the DNA sequencing of the virus subtype

Low risk (to develop carcinoma): 6 and 11 (Causes condyloma)

High Risk (to develop carcinoma): 16, 18, 31, 33 (Causes dysplasia –> carcinoma)

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6
Q

What is lichen sclerosis?

A

Thinning of epidermis and fibrosis of underlying dermis

  • Leukoplakia with parchment-like vulvar skin
  • Most commonly seen in postmenopausal women
  • Benign, associated with slightly increased risk of squamous cell carcinoma
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7
Q

What is lichen simplex chronicus?

A

Hyperplasia of vulvar squamous epithelium

  • Leukoplakia with thick, leathery vulvar skin
  • Associated with chronic irritaion and scratching
  • Benign; no increased risk of squamous cell carcinoma
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8
Q

What is the clinical presentation of vulvar carcinoma?

A

Arises from squamous epithelium lining vulva

  • Relatively rare
  • Presents as leukoplakia (similar to lichen sclerosis or lichen simplex chronicus)
  • -> Biopsy required
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9
Q

What can lead to vulvar carcinoma?

A

May be HPV: High risk infxn: 16, 18, 31, 33
- Younger ages: 40-50yrs old
or
Non-HPV: long standing lichen sclerosis
- Older ages: 65-75yrs old
- post-menopausal

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10
Q

What is extramammary Paget Disease?

A

Malignant epithelial cell in the epidermis of the vulva

  • Presents as erythematous, pruritic, ulcerated skin
  • Represents carcinoma in situ, usually no underlying carcinoma

–> Can be seen in the nipple (Paget disease of the nipple)

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11
Q

How is extramammary Paget Disease (carcinoma) distinguished from melanoma?

A

Paget Cells: PAS+, keratin+, and S100-

Melanoma: PAS-, keratin-, and S100+

**PAS marks mucus, so only epithelial cells will be stained b/c they make mucus

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12
Q

What is adenosis?

A

Focal persistence of columnar epithelium in the upper 1/3 of vagina (derived from mullerian duct)

  • Increased incidence in females exposed to DES in utero
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13
Q

What is a rare complication of DES-associated vaginal adenosis?

A

Clear cell adenocarcinoma

  • Malignant proliferation of glands with clear cytoplams
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14
Q

What is embryonal rhabdomyosarcoma?

A

Malignant mesenchymal proliferation of immature skeletal muscle – very rare

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15
Q

What is the presentation of embryonal rhabdomyosarcoma?

A

Bleeding and grape-like mass protruding from vagina or penis of child, usually < 5yrs old

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16
Q

What is the malignant cell in rhabdomyosarcoma?

A

Rhabdomyoblast

  • Immature cells with cytoplasmic cross-striations
  • Cells stain IHC staining for desmin (indicating muscle cell) and myoglobin (indicating myoblast)
17
Q

What is vaginal carcinoma and it’s key risk factor?

A

Carcinoma arising from squamous epithelium lining the vaginal mucosa

  • Usually related to high-risk HPV (16, 18, 31, 33)
  • Precursor lesion is vaginal intraepithelial neoplasia (VAIN)
18
Q

What is the regional lymph node spread for:

lower 2/3 of vagina?

upper 1/3 of vagina?

A

Lower 2/3: develops from Urogenital Sinus
–> spreads to inguinal nodes

Upper 1/3: develops from Mullerian duct
–> spreads to regional iliac nodes

19
Q

What are the divisions of the cervix?

A

Exocervix: squamous epithelium

Endocervix: columnar epithelium

  • Division is extremely clear on histology
20
Q

What is HPV?

A

A DNA virus; sexually transmitted

Infects the lower genital tract, especially cervix in the transformation zone

  • Persistent infection leads to risk for Cervical Intraepithelial Neoplasia (CIN)
21
Q

What makes High-risk HPV high risk?

A

HPV 16, 18, 31, and 33

Produce proteins:

  • *E6**: increases destruction of p53
  • *E7**: increases destruction Rb
22
Q

What is the histological presentation of Cervical Intraepithelial Neoplasia?

A
  • Koilocytic change (due to HPV infxn)
  • Nuclear atypia
  • Increased mitotic activity
  • Divided into grades based on extent of immature, dysplastic cells:
  • -> CIN I, II, and III have possibility of reversing; but when they develop into carcinoma in situ, there is no reversing
23
Q

What are characteristics of cervicl carcinoma?

A

Invasive carcinoma that arises from cervical epithelium

  • Most commonly seen in middle-aged women (40-50yrs old)
  • Presents as vaginal bleeding (either randomly or post-coital)
24
Q

What are key risk factors for cervical carcinoma?

A

High-risk HPV infection (16, 18, 31, 33)

  • Secondary risk factors include:
    Smoking
    Immunodeficiency
25
Q

What are the two types of cervical carcinoma?

A

Sqaumous cell

or

Adenocarcinoma

(Both HPV driven)

26
Q

What is the classic finding of advanced cervical cancer?

A

Hydronephrosis

  • Advanced Cervical cancer often invades through the anterior uterine wall into the bladder and blocks the ureters

–> can lead to post-renal failure and death

27
Q

What is the gold standard for screening of cervical cancer? Why is it necesary?

A
  • *Pap Smear**
  • Goal is to catch dysplasia before it develops into carcinoma (takes 10-20 years for carcinoma to develop and identified dysplasia can be removed to prevent carcinoma)
28
Q

What are limitations of pap smear?

A
  • Inadequate sampling of transformation zone resulting in false negative screening
  • Limited efficacy in screening for adenocarcinoma (better for squamous cell carcinoma)
29
Q

What is the current immunization for HPV?

A

Quadrivalent vaccine: HPV 6, 11, 16, 18

Protection lasts for 5 years

Pap smears still necessary

Module 6: Repro/Endocrine (28 decks)

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